Senior Vice President, Compliance
Senior Vice President, Compliance
Position Purpose: Ensure regulatory compliance with state and other government agencies related to the health insurance industry.
: Develop and implement strategic vision for compliance and ethics culture within the business unit ensuring alignment with Corporate
: Ensure business unit are in compliance with state and federal program regulations, insurance regulations, regulatory requirements for business entities and state contract requirements
: Develop policies, procedures, and processes to ensure compliance with state law, federal law, contract requirements, and various standards
: Oversee compliance integration and support of business operations and support units
: Oversee, administer, and implement various compliance programs, including fraud and abuse and HIPAA
: Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements related to regulatory and contract language
: Develop strategic relationships with state and federal regulators and assist with the development of internal and external policies concerning state insurance, Managed Care Organization, Medicare and Medicaid regulations and initiatives
: Identify, evaluate and analyze the impact of state and federal, regulation, policy and contract requirements; resulting issues, develop positions, alternatives, recommendations advise management concerning impact
: Oversee fraud and abuse programs on the health plan level, collaborating with the special investigation unit team and serving as main regulatory liaison
: Oversee development or adoption of Corporate's special investigation, ethics and compliance training to include delivery, monitoring and reporting
: Conduct compliance monitoring, develop and implement performance improvement plans, corrective action plans, and report on achievement of action plans to senior management
: Oversee the maintenance and tracking of laws and regulations, contract documentations, amendments, and various compliance measures and ensure appropriates are taken to address changes
: Bachelor' s degree in Public Policy, Government Affairs, Business Administration or related field.
: 10+ years of compliance program management and contract experience.
: Extensive knowledge of state administrative code and regulations, state insurance laws and regulations including managed care regulations.
: Experience with state and federal government agencies, accreditation bodies, participating provider agreements, HIPAA and Third Party Administration (TPA) laws, credentialing regulations and prompt pay laws.
: Master's or Law degree preferred.
: 15+ years of program management and contract experience preferred.
More information about the job
Is Relocation Available?
Is there a bonus structure?
20% or higher
Does this position have direct reports?
Who does this position report to?
Plan President & CEO
What are the 3-4 non-negotiable requirements on this position?
Senior level compliance background. 15+ years. Vice-President or above. Not looking for a Director to make a step up. Very professional communication skills. Able to work in a Matrix environment (making sure others are completing their work, but do not report to them).
What are the nice-to-have skills?
Contract Administration experience